Graduate Defense: Sydney Fox

Dissertation Information

Title: The Opioid Epidemic In Virginia: A Comparative Case Study Of County-Level Implementation Of Opioid Response Plans

Program: Doctor of Philosophy in Public Policy and Administration

Advisor: Dr. Elizabeth Fredericksen, School of Public Service

Committee Members: Dr. Andrew Giacomazzi, School of Public Service and Dr. Chris Birdsall, School of Public Service

Abstract

This project entails a mixed method review of the implementation of opioid policies in the 133 cities and counties of the Commonwealth of Virginia using van Meter and van Horn’s (1975) Model Theoretical Framework as a guide. This study focuses upon understanding how the characteristics of successful implementation intersect with the components of opioid policy, controlling for education, poverty, and health insurance coverage, and how that interaction may lead to reduced overdose deaths. According to van Meter and van Horn, political agreement is necessary to create a policy with an administrative mechanism to implement. This administrative mechanism, along with resources, is then critical to successful implementation of policy.

Findings include a positive association between political agreement and the existence of a plan. However, simply having a plan in place did not significantly associate with lowered all cause opioid deaths without attendant resources. When counties have a plan with resources in place, there is a 7 death per 100,000 decrease in the overdose death rate for that county. This finding implicates the importance of resources in counties with plans in place. When policymakers are developing opioid plans, it is important that they include specific, earmarked resources to use for mitigation plans in their communities. Plans without resources are unfunded mandates, and as this study shows, they are less robust than plans with resources in terms of actually reducing the overdose rates.

Taken together, these findings and this study contribute to the theoretical framework in important ways. First, the application of the van Meter and van Horn model framework contributes to implementation theory building by applying these components of implementation characteristics to a new field of study. Additionally, this study contributes to opioid policy theory building by engaging in implementation theory testing within the opioid policy realm. While these models suffered from a time constraint in that the dataset was incomplete at the time of the study since opioid deaths were still trending upward, the models could easily be tested further given a couple more years of time. This will continue to help build on the evidence base of opioid policy implementation at the local level.